How much does Medicare pay for CPT 19301?

Medicare allowed an average of $655.12 per service and paid $520.48 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $2662.87, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 19301?

Partial removal of breast. It was billed 53,164 times to 49,028 Medicare beneficiaries by 1,894 providers in 2024.

Does 19301 pay differently in an office than a hospital?

Yes. The allowed amount averaged $674.58 in an office setting and $654.27 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 19301 most?

General Surgery, with 34,195 services from 1,258 clinicians. Next are Surgical Oncology, Ambulatory Surgical Center, Physician Assistant.

CPT 19301

Partial removal of breast

$655.12Medicare-allowed amount per service, averaged across 53,164 services

Providers submitted

$2662.87

Asking price, not received

Medicare allowed

$655.12

The fee schedule figure

Medicare paid

$520.48

Balance is patient coinsurance

Providers submitted an average of $2662.87 for this code and Medicare allowed $655.12 — 4.1× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $520.48 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $674.58
Hospital / facility: $654.27

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 2,241 services were billed in an office setting and 50,923 in a facility.

Services: 53,164
Beneficiaries: 49,028
Providers billing it: 1,894
Total allowed: $34,828,800

What Medicare pays for CPT 19301

Across 53,164 services billed by 1,894 providers to 49,028 beneficiaries, Medicare allowed an average of $655.12 per service. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 19301

Specialty	Services	Beneficiaries	Avg allowed	Providers
General Surgery	34,195	31,506	$628.30	1,258
Surgical Oncology	11,029	10,201	$644.04	364
Ambulatory Surgical Center	4,989	4,511	$1108.41	143
Physician Assistant	1,687	1,627	$81.68	72
Nurse Practitioner	445	419	$83.96	19
General Practice	177	167	$668.64	7
Obstetrics & Gynecology	174	167	$642.55	10
Undefined Physician type	88	80	$668.67	3
Plastic and Reconstructive Surgery	75	74	$633.50	4
Hematology-Oncology	75	68	$667.94	3
Gynecological Oncology	67	64	$641.63	3
Colorectal Surgery (Proctology)	51	45	$667.51	2
Vascular Surgery	26	20	$698.69	1
Internal Medicine	20	19	$538.07	1
Hand Surgery	18	16	$617.50	1

19301 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
California	5,819	$663.35	$475.88	190
Florida	3,602	$677.59	$502.42	122
New York	3,334	$704.25	$481.78	117
Texas	3,281	$642.70	$511.80	124
Pennsylvania	2,609	$677.67	$533.51	92
Illinois	2,194	$693.70	$503.79	81
Virginia	2,173	$662.67	$529.38	65
North Carolina	2,025	$639.11	$541.15	66
Maryland	1,795	$747.99	$562.98	46
New Jersey	1,674	$779.88	$565.85	63
Massachusetts	1,641	$670.94	$505.42	48
Arizona	1,534	$634.86	$515.52	44
Ohio	1,387	$624.83	$504.95	60
Tennessee	1,258	$641.75	$557.93	44
Georgia	1,251	$641.90	$508.71	55
Indiana	1,234	$662.26	$556.31	51
Washington	1,216	$641.13	$490.45	48
Michigan	1,149	$628.95	$482.74	48
South Carolina	1,113	$625.34	$515.85	37
Colorado	968	$757.61	$608.28	40
Missouri	895	$576.51	$476.34	32
Oregon	889	$623.18	$491.36	34
Kansas	685	$523.75	$452.74	21
Kentucky	652	$656.35	$535.96	25
Wisconsin	624	$603.73	$517.33	32
Arkansas	589	$677.33	$593.16	18
Iowa	556	$550.96	$478.16	18
Minnesota	556	$564.30	$465.15	27
Oklahoma	551	$598.58	$503.45	15
Connecticut	508	$665.22	$478.61	24
Utah	444	$528.24	$433.34	18
New Hampshire	428	$671.06	$518.16	16
Nebraska	416	$622.06	$531.05	11
Louisiana	396	$620.42	$518.64	18
Alabama	391	$612.41	$549.59	18
Idaho	365	$493.44	$418.88	18
Delaware	313	$643.05	$512.18	8
Maine	307	$528.59	$424.39	12
Mississippi	281	$537.26	$455.96	8
South Dakota	265	$388.88	$327.88	8
Nevada	251	$409.92	$331.73	9
District of Columbia	241	$712.83	$500.68	6
Rhode Island	235	$549.81	$437.05	11
Montana	228	$612.33	$476.39	9
North Dakota	167	$651.53	$542.24	8
Alaska	158	$957.99	$643.06	5
New Mexico	148	$635.04	$499.89	7
West Virginia	119	$561.01	$445.99	6
Hawaii	110	$643.38	$505.66	3
Vermont	75	$608.74	$511.95	4
Wyoming	64	$533.67	$433.74	4

Related codes

19303Simple complete removal of breast$1046.29

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.